4
Treatment
Acute Phase
Î Reduce stressful environmental factors
Î Educate patient
• Nature and management of illness
Î Establish relationship with patient's family
• Refer family members to the National Alliance for the Mentally Ill (NAMI)
(http://www.nami.org )
Use of Antipsychotics
Î Initiate treatment as soon as possible
Î Discuss medication risks and benefits with patient and obtain patient
consent whenever possible
Î Minimize side effects
Î Select medication based on:
Note: Antipsychotics tend to have the same efficacy for positive symptoms in
population-based studies.
Î Titrate as quickly as tolerated to the target therapeutic dose
Î If the patient is not improving, assess for:
• Medication nonadherence
• Rapid medication metabolism
• Poor medication absorption
• Consider measuring medication plasma concentration
Note: If the patient has adequate medication plasma concentration but is not
responding to treatment, raise dose or switch medications.
• Severity of symptoms
• Prior degree of symptom response
• Prior experience of side effects
• Dosing convenience (eg, once daily)
• Side effect profile of medication
• Patient's preference
• Available formulation
